To the Editor.—Physicians have a primary responsibility to protect patients, rather than payers, from harm. The article by Dr Fix and colleagues1 only addresses the cost of treating early-stage Lyme disease (LD). Only 5 of the 242 patients received intravenous antibiotics within the brief span of the study. To calculate the total cost of an illness, it is necessary to calculate the cost of treatment and the cost of illness. Vanderhoff2 has previously calculated the cost of treating late-stage Lyme disease. Clearly, if the $47595 spent on 232 patients in the study by Fix et al1 prevents only one case of chronic LD, it is a total cost saving in terms of both money and patient suffering.